SUCCESSFUL APPLICATION OF THE NORWOOD PROCEDURE FOR INFANTS WITHOUT HYPOPLASTIC LEFT-HEART SYNDROME

Although the first-stage Norwood procedure mostly has been used for hy poplastic left heart syndrome, there are other anomalies in which the Norwood procedure can be applied. Since 1991, 18 newborns without hypo plastic left heart syndrome underwent a first-stage Norwood procedure. All had a hypoplastic aortic annulus, ascending aorta, and transverse aorta. Ten had normally related great arteries: aortic atresia or aor tic stenosis with inadequate left ventricle in 4, mitral atresia or st enosis in 4, and interrupted aortic arch in 2. The 8 others had double -outlet right ventricle with mitral atresia or complete transposition with a hypoplastic right ventricle. Age ranged from 2 to 77 days (medi an, 6 days) and weight from 2.4 to 4.4 kg (mean, 3.0 kg). The patients with interrupted aortic arch simultaneously underwent primary repair of the interruption. There were 17 hospital survivors (94%). There hav e been no late deaths in follow-up from 4 to 30 months (mean 15.5 mont hs). Thirteen children have had subsequent creation of a bidirectional Glenn shunt with takedown of the original systemic to pulmonary shunt . The 2 with interrupted aortic arch underwent a Rastelli-type biventr icular repair. These results show that the Norwood procedure can be ap plied to infants without hypoplastic left heart syndrome who have hypo plastic aortas and excessive pulmonary blood now with very low mortali ty and excellent palliation.